Individual
KHALIAH SALEEM MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5236 DELANCEY ST, PHILADELPHIA, PA 19143-1506
(267) 259-9199
Mailing address
5236 DELANCEY ST, PHILADELPHIA, PA 19143-1506
(267) 259-9199
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH004078
PA
Other
Enumeration date
01/07/2020
Last updated
05/06/2022
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